Monitoring Right Ventricular Hemodynamic Function During Pacing Optimization

• US 20090118783A1
• Filed: 09/22/2008
• Published: 05/07/2009
• Est. Priority Date: 11/01/2007
• Status: Active Grant

• Current Assignee: Cardiac Pacemakers Incorporated (Boston Scientific Corporation)
• Original Assignee: Cardiac Pacemakers Incorporated (Boston Scientific Corporation)
• Inventors: Patangay, Abhilash, Maskara, Barun, Kwok, Jonathan, Yu, Yinghong, Ding, Jiang
• Granted Patent: US 8,352,032 B2
• Time in Patent Office: Days
• US Class Current: 607/18
• CPC Class Codes: A61N 1/3627 for treating a mechanical deficiency of the heart, e.g. congestive heart failure or cardiomyopathy
• CPC Class Codes: A61N 1/36564 controlled by blood pressure
• CPC Class Codes: A61N 1/36585 controlled by two or more physical parameters
• CPC Class Codes: A61N 1/36592 controlled by the heart rate variability
• CPC Class Codes: A61N 1/3682 with a variable atrioventricular delay
• CPC Class Codes: A61N 1/3684 for stimulating the heart at multiple sites of the ventricle or the atrium
• CPC Class Codes: A61N 1/36842 Multi-site stimulation in the same chamber
• CPC Class Codes: A61N 1/36843 Bi-ventricular stimulation

Abstract

Method and systems related to monitoring right ventricular function during pacing by a cardiac rhythm management device are described. One or more pacing parameters are selected to provide cardiac resynchronization therapy. For example, the one or more pacing parameters may be selected to provide an optimal or improved therapy. The heart is paced using the selected pacing parameters. While pacing with the selected parameters, pressure is sensed via a pressure sensor disposed the pulmonary artery. The sensed pressure is analyzed to determine right ventricular function achieved during the pacing using the selected pacing parameters. A signal, such as an alert signal or control signal, is generated based on the right ventricular function achieved during the pacing.

Claims

1. A method of operating a cardiac rhythm management device, comprising:

selecting one or more pacing parameters to provide cardiac resynchronization therapy;

pacing the heart using the selected pacing parameters;

sensing pressure using a pressure sensor disposed in a pulmonary artery during the pacing with the selected parameters;

analyzing the pressure to determine right ventricular function achieved during the pacing using the selected pacing parameters; and

generating a signal if the right ventricular function degrades during the pacing.

2. The method of claim 1, wherein the one or more pacing parameters comprise a pacing timing interval.

3. The method of claim 1, wherein the one or more pacing parameters comprise one or both of an atrioventricular delay interval and an interventricular delay interval.

4. The method of claim 1, wherein the one or more pacing parameters comprise one or more of a pacing site, a pacing mode, and a pacing sequence.

5. The method of claim 1, wherein the one or more pacing parameters are selected to improve left ventricular function under various patient conditions.

6. The method of claim 5, wherein the various patent conditions comprise various patient postures or various patient activity levels.

7. The method of claim 1, wherein selecting the one or more pacing parameters comprises selecting the pacing parameters based on intrinsic electrical or mechanical events that have a predictable relationship to delivery of optimally timed pacing pulses.

8. The method of claim 1, wherein selecting the one or more pacing parameters comprises selecting the one or more pacing parameters based on measured left ventricular hemodynamic function.

9. The method of claim 1, wherein selecting the one or more pacing parameters comprises determining the one or more pacing parameters based on echocardiographic or electrophysiological studies.

10. The method of claim 1, wherein pacing the heart using the selected pacing parameters comprises pacing the heart using an acute burst protocol.

11. The method of claim 1, wherein analyzing the pressure to determine the right ventricular function comprises determining one or more of pulmonary artery end diastolic pressure (PAEDP), pulmonary artery end systolic pressure (PAESP), pulmonary artery pulse pressure (PAPP), RV dp/dt_max, RV dp/dt_min, and PAEDP timing.

12. The method of claim 1, wherein generating the signal comprises generating an alert if the right ventricular function degrades.

13. The method of claim 1, further comprising allowing an override of the one or more pacing parameters to achieve an improvement in the right ventricular function.

14. The method of claim 1, further comprising automatically modifying the pacing parameters to achieve an improvement in the right ventricular function.

15. A cardiac rhythm management system, comprising:

a cardiac resynchronization optimization module configured to determine pacing parameters for cardiac resynchronization therapy (CRT);

pacing therapy circuitry configured to deliver pacing using the CRT pacing parameters;

a pulmonary artery pressure sensor disposed in the pulmonary artery and configured to sense pulmonary artery pressure;

a right ventricular function analysis module configured to analyze the measured pressure to determine right ventricular function achieved during the pacing; and

a controller configured to generate a signal responsive to a change in the right ventricular function during the pacing.

16. The system of claim 15, further comprising a sensor to determine various patient conditions, wherein the CRT optimization module is configured to determine the selected pacing parameters as one or more optimal pacing parameters for the various patient conditions.

17. The system of claim 16, wherein the various patient conditions comprise various patient postures or various patient activity levels.

18. The system of claim 15, wherein the CRT optimization module is configured to determine the pacing parameters based on intrinsic electrical or mechanical events that have a predictable relationship to delivery of optimally timed pacing pulses.

19. The system of claim 15, wherein the right ventricular function analysis module in conjunction with the pulmonary artery pressure sensor and the controller are configured to test the CRT parameters for degradation of right ventricular function by sensing the pulmonary pressure during an acute burst pacing protocol.

20. The system of claim 15, wherein the controller is configured to generate an alert or automatically override the CRT pacing parameters if degradation of the right ventricular function is detected.